發(fā)布時(shí)間：2018-04-04 08:19

  本文選題：計(jì)算機(jī)輔助設(shè)計(jì)　切入點(diǎn)：骨腫瘤　出處：《廣州中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：目的：通過(guò)計(jì)算機(jī)輔助設(shè)計(jì)(CAD)、計(jì)算機(jī)輔助制作(CAD)、增量制作技術(shù)(RP)逆向工程(RE)等數(shù)字化技術(shù),研究計(jì)算機(jī)輔助原發(fā)性骨腫瘤精確切除、大段骨缺損修復(fù)、肢體功能重建的方法,探討計(jì)算機(jī)輔助技術(shù)治療骨腫瘤與大段骨缺損的臨床價(jià)值。方法：一、回顧性研究應(yīng)用計(jì)算機(jī)輔助技術(shù)對(duì)骨腫瘤精確切除與術(shù)后大段骨缺損修復(fù)重建的病例,其中骶骨惡性腫瘤7例,股骨上段良性骨腫瘤8例,膝關(guān)節(jié)周圍惡性骨腫瘤11例。所有病例術(shù)前都通過(guò)CT或MRI掃描獲取腫瘤及其周圍組織的二維圖像數(shù)據(jù),導(dǎo)入Mimicsl0.01軟件三維重建骨關(guān)節(jié)三維模型、腫瘤侵襲或浸潤(rùn)模型；并根據(jù)腫瘤性質(zhì)借助Imageware軟件三維匹配、分析確定骨腫瘤外科切除邊界；術(shù)前用Imageware.UG-NX軟件設(shè)計(jì)個(gè)性化手術(shù)輔助模板,并采用數(shù)字化仿真模擬骨腫瘤精確切除和重建過(guò)程；最后按術(shù)前預(yù)設(shè)方案,在手術(shù)輔助模板引導(dǎo)下精確實(shí)施骨腫瘤切除、大段骨缺損修復(fù)重建手術(shù)。二.SPSS16.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理：計(jì)量資料使用平均數(shù)(x±s)表示,采用兩獨(dú)立樣本t檢驗(yàn),P0.05為具有統(tǒng)計(jì)學(xué)意義；計(jì)數(shù)資料采用Fisher確切概率法,P0.05為具有統(tǒng)計(jì)學(xué)意義。結(jié)果：一、7例骶骨腫瘤均采取雙側(cè)釘棒固定腰椎和骨盆,手術(shù)時(shí)間為255-640min,平均475.86±119.91min；術(shù)中出血2000-7000,平均出血量為4725±1561.82m1。主要并發(fā)癥：1例大小便不能控制和性功能喪失,1例未恢復(fù)性功能并術(shù)后傷口感染,1例因不慎摔傷致內(nèi)固定棒斷裂,1例骶骨脊索瘤術(shù)后3年復(fù)發(fā)。二、8例股骨上段腫瘤行大段異體骨+內(nèi)固定的保髖重建術(shù),術(shù)中出血400-2000m1,平均1181.21±721.08m1。隨訪12-38個(gè)月,末次隨訪記錄：8例均未見腫瘤復(fù)發(fā),未出現(xiàn)明顯并發(fā)癥,MSTS評(píng)分平均27.75±2.87分,優(yōu)7例,良1例。三、11例計(jì)算機(jī)輔助膝關(guān)節(jié)周圍骨腫瘤手術(shù)與14例常規(guī)手術(shù)效果比較：1.兩組手術(shù)患者年齡、性別、術(shù)前疼痛評(píng)分(VAS評(píng)分)無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。2.術(shù)中腫瘤瘤段切除長(zhǎng)度、手術(shù)出血量無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。3.術(shù)后1年復(fù)發(fā)率CAD手術(shù)組為9.09%,傳統(tǒng)手術(shù)組為14.28%；并發(fā)癥CAD手術(shù)組18.18%,傳統(tǒng)手術(shù)組28.57%；Fisher確切概率法檢驗(yàn)P0.05,尚不能證明兩種手術(shù)方式在1年后復(fù)發(fā)率和并發(fā)癥不同。4.保肢功能評(píng)分CAD手術(shù)組末次隨訪MSTS評(píng)分23-30分,其中優(yōu)9例,良2例,平均為27.36±2.42分；傳統(tǒng)手術(shù)組末次隨訪MSTS評(píng)分17-28分(排除1例截肢病例,13例納入統(tǒng)計(jì)),其中優(yōu)10例、良2例、中1例,平均為24.23±3.75分,采用兩獨(dú)立樣本資料的t檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)分析,t=2.379,p0.05,具有統(tǒng)計(jì)學(xué)意義。患者膝關(guān)節(jié)主動(dòng)屈曲活動(dòng)度比較,CAD手術(shù)組的膝關(guān)節(jié)主動(dòng)屈伸活動(dòng)度80-120°,平均114.55±12.93°；傳統(tǒng)手術(shù)組膝關(guān)節(jié)主動(dòng)屈伸活動(dòng)度70-120°(排除1例截肢病例,13例納入統(tǒng)計(jì)),平均102.31±12.18°,采用兩獨(dú)立樣本資料的t檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)分析,t=2.385,p0.05,具有統(tǒng)計(jì)學(xué)意義。結(jié)論：計(jì)算機(jī)輔助技術(shù)可以在保留最大范圍正常骨骼的情況下精確切除骨腫瘤、個(gè)性化重建骨缺損區(qū)域和恢復(fù)骨關(guān)節(jié)功能,該技術(shù)與傳統(tǒng)手術(shù)方法相比具有明顯優(yōu)勢(shì)。
[Abstract]:Objective : To study the clinical value of computer - aided design ( CAD ) , computer - aided manufacturing ( CAD ) and incremental manufacturing ( RP ) reverse engineering ( RE ) .
and performing three - dimensional matching according to the tumor nature with the Imageware software to analyze and determine the resection boundary of the bone tumor ;
Preoperative Imageware . UG - NX software was used to design individualized surgical assistant template , and digital simulation was used to simulate the process of precise resection and reconstruction of bone tumor ;
At last , according to the pre - operative preset scheme , bone tumor resection and segmental bone defect repair and reconstruction were accurately performed under the guidance of the surgical assistant template . The second , SPSS 16.0 software was used for statistical treatment : the mean ( x 鹵 s ) of the measurement data was expressed by the mean ( x 鹵 s ) of the measurement data , and the difference was statistically significant with the two independent samples t test .
Results : One , seven cases of sacral tumors were treated with bilateral nail rods to fix the lumbar vertebrae and pelvis , the operation time was 255 - 640min , the mean 476.86 鹵 119.91min ;
The average hemorrhagic volume was 4725 鹵 1561 . 82m1 . Major complications were : 1 case was unable to control and lose sex function , 1 case did not recover sexual function and postoperative wound infection , 1 case had no significant complication after operation , 1 case had no significant complication , 1 case had no statistical difference ( p . 05 ) due to incomplete injury , 1 year recurrence rate CAD operation group was 9.09 % , and the traditional operation group was 14.28 % ;
The complications were 18.18 % in CAD group and 28.57 % in traditional operation group .
Fisher ' s exact probability method was used to test the difference of recurrence rate and complication after 1 year .
At the end of the traditional operation group , the MSTS score was 17 - 28 points ( excluding 1 amputation case , 13 cases included statistics ) . Among them , 10 cases were excellent , 2 cases were good , 1 case was middle , average 24.23 鹵 3.75 points , t = 2.379 , p . 05 , which had statistical significance . Compared with the active flexion range of knee joint , the active flexion and extension activity of knee joint in CAD operation group was 80 - 120 擄 , mean 114.5 鹵 12.93 擄 ;
Conclusion : Computer - assisted technique can accurately remove bone tumor , individualized reconstruction of bone defect area and restoration of bone joint function in the condition of retaining normal bone in the maximum range , which has obvious advantages compared with traditional surgical method .

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R738.1

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